HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED !
Date: k4"t-7 Permit Number:T�
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fora'Pierce Ft 34982 /"'
Phone:(772)462-x.553 Fax:(772)462-x.578 Commercial Residential V-101
PERMIT APPLICATION FOR: eelcop„� ���
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Address: =1l�� 11 � �
Legal Description: d:j
Property Tax ID#l: i{'c•-5- ?2Lot No. �_
Site Plan Name: Block Block No.
Project Name:'
Setbacks Front Back: Right Side: Left Side:
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itiona ayor to a pe orme under this permit-check all that app y:
—Mechanical ,Gas Tank _Gas Piping _Shutters �Windows/Doors
Electric _Plumbing i Sprinklers _Generator VRoof
Total Sq_Ft of Construction: ) 4OD sq_Ft.of First Floor:
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Cost of Construction:$A tp
(2 _ Utilities: Sewer Septic Building Height:
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Name IJ Name:
Addre
Company: C
City: +-:S>-t Lo eze-, Stater Address: 0
Zip Code:, Q-57Z Fax: _ City..&L State:
Phone No.41�L-��-Q ,5, Zip Cade: Fax-
E-Mail: Phone No -
Fill in fee simple Title Holder on next page(If different E-Mail - .S
from the Owner listed above) State or County License_�f[
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
i ':.n:•• .. .r ip",
SUPPLEMENTAL,Cflf�STRS_U�TId `SEIiAW INFQRIIATIOV
1 6 a t 1
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict unth any applicable Home Oviners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,svAmming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing,consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Signature o wner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA < �L`�
COUNTYOF i+tip COUNTY OF ✓✓�/
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of .20_ by this day of ,20_ by
(Name of pe on acknowledging) (Name of person knowledging)
An& vaw-s��
( ' ature of Notary Public-StateW Florida (Sigdatdre of Notary Public-State If Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification.
Type of Identification Type of Identification
Produc d Produced
Commission No. I?ai) Commission No. #
1
LASHAHNAG �.tPayLASHAHNA INGRAM�0
,
;��: Notary Pub!c 5 .: u u• a` Notar Public statg.of FIG-id
-
•_My Comm. xpne_ uac�. �� = 0-
$. _ I, "sN� •=My C mm.Expires Dec 20, 0
REVIEWS FRO o,, INCPmmi isufth`]I� �2 PLANS VEGETATION ;e P1 LE Co �NGRIO1(1=j2,a;
COON Ea 1-i 1`"t Vl Fd lhro gh N,' y Ass . EVIEW REVIEWsonde throgEViEW Nota,S y,
.. �:
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2-014